Abdominal complications of ascariasis in childhood.

OBJECTIVE: Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. DATA SOURCES: A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. SUMMARY OF FINDINGS: Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. CONCLUSION: The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

Torsion of Granulosa Cell Tumor of the Ovary in a Preschool Patient: A Rare Cause of Acute Abdomen.

BACKGROUND Granulosa cell tumor of the ovary is very rare in childhood; its most common clinical manifestation is isosexual precocious puberty. Clinical presentation as acute abdomen due to pain and ovarian torsion is rare, but a granulosa cell tumor must be suspected in a patient with this acute presentation and signs of early puberty. Adult-type granulosa cell tumor is an even rarer occurrence in children. CASE REPORT We report a case of torsion of adult-type granulosa cell tumor of the ovary in a 5-year-old patient with acute abdominal pain and ovarian torsion and highlight the importance of histological diagnosis of this tumor for the therapeutic plan and progression of these patients. CONCLUSIONS Precocious puberty, pain, abdominal distension, and an ultrasonography with suspicion of ovarian torsion are warning signs that may indicate the presence of a gonadal stromal tumor in pediatric patients seen at an emergency unit. These patients require long-term follow-up by a pediatrician and gynecologist because of the potential for late recurrence.

Torsion of a Communicating Hydrocele Presented as Acute Scrotum: A Case Report and Literature Review.

Torsion of a communicating hydrocele is extremely rare, and the cause is unclear. We report the case of a 3-year-old boy referred to us with acute scrotum. Operative findings revealed torsion of a communicating hydrocele with a 360-degree rotation of the distal end. We performed surgical excision of the necrotic cystic mass and high ligation of the peritoneal communication. A high index of suspicion is required for the correct diagnosis and treatment of this condition, which should be included among the causes of acute scrotum in childhood.

Choledochal cyst in childhood: review of 30 cases.

OBJECTIVE: To analyze and discuss the clinical data, diagnosis and treatment of a number of patients with cystic dilatation of the common bile duct of a Brazilian pediatric hospital. METHODS: We analyzed 30 patients treated at the Martagão Gesteira Institute of Pediatrics and Child Care of the Federal University of Rio de Janeiro for 23 years ,with statistical analysis of epidemiological data, clinical manifestations, diagnosis, treatment and postoperative outcome. RESULTS: We observed a marked female predominance (73.4% of cases), the diagnosis being made in the first decade of life in 90% of patients. The most prevalent clinical manifestation was jaundice (70% of cases) and the classic triad of choledochal cyst was not observed. Abdominal ultrasound was the first imaging examination performed, with a sensitivity of 56.6%, with diagnostic definition in 17 children. Two patients (6.6%) had prenatal diagnosis. All patients underwent surgical treatment, cyst resection with Roux-en-Y hepaticojejunostomy being performed in 80% of cases. The incidence of postoperative complications was 13.3% and the mortality rate was 6.6%, ie two patients were diagnosed with Caroli's disease. CONCLUSION: The non-observance of the classic triad of choledochal cyst suggests that its incidence is lower than that reported in the medical literature. The surgical treatment of choledochal cysts, with resection and bilioenteric anastomosis, is safe even for small children.

Choledochal cyst in childhood: review of 30 cases / Cisto de colédoco na infância: revisão de 30 casos

Objective: To analyze and discuss the clinical data, diagnosis and treatment of a number of patients with cystic dilatation of the common bile duct of a Brazilian pediatric hospital. Methods: We analyzed 30 patients treated at the Martagão Gesteira Institute of Pediatrics and Child Care of the Federal University of Rio de Janeiro for 23 years ,with statistical analysis of epidemiological data, clinical manifestations, diagnosis, treatment and postoperative outcome. Results: We observed a marked female predominance (73.4% of cases), the diagnosis being made in the first decade of life in 90% of patients. The most prevalent clinical manifestation was jaundice (70% of cases) and the classic triad of choledochal cyst was not observed. Abdominal ultrasound was the first imaging examination performed, with a sensitivity of 56.6%, with diagnostic definition in 17 children. Two patients (6.6%) had prenatal diagnosis. All patients underwent surgical treatment, cyst resection with Roux-en-Y hepaticojejunostomy being performed in 80% of cases. The incidence of postoperative complications was 13.3% and the mortality rate was 6.6%, ie two patients were diagnosed with Caroli's disease. Conclusion: The non-observance of the classic triad of choledochal cyst suggests that its incidence is lower than that reported in the medical literature. The surgical treatment of choledochal cysts, with resection and bilioenteric anastomosis, is safe even for small children. .

Objetivo: analisar e discutir os dados clínicos, o diagnóstico e tratamento de uma série de pacientes portadores de dilatações císticas do colédoco de um hospital pediátrico brasileiro. Métodos: foram analisados 30 pacientes tratados no Instituto de Pediatria e Puericultura Martagão Gesteira da Universidade Federal do Rio de Janeiro durante 23 anos, com análise estatística de dados epidemiológicos, manifestações clínicas, diagnóstico, tratamento e evolução pós-operatória. Resultados: foi observada marcada predominância do sexo feminino (73,4% dos casos), sendo o diagnóstico feito na primeira década de vida em 90% dos pacientes. A manifestação clínica mais prevalente foi a icterícia (70% dos casos) e a tríade clássica do cisto de colédoco não foi observada. A ultrassonografia abdominal foi o primeiro exame de imagem realizado, demonstrando sensibilidade de 56,6%, com definição diagnóstica em 17 crianças. Dois pacientes (6,6%) tiveram diagnóstico pré-natal. Todos os pacientes foram submetidos a tratamento cirúrgico, sendo a ressecção do cisto com hepaticojejunostomia com Y de Roux realizada em 80% dos casos. A incidência de complicações pós-operatórias foi 13,3% e a taxa de mortalidade foi 6,6%, ou seja, dois pacientes com diagnóstico de doença de Caroli. Conclusão: a não observação da tríade clássica do cisto de colédoco nos pacientes avaliados sugere que a sua incidência seja menor que a relatada na literatura médica mundial. O tratamento cirúrgico dos cistos de colédoco, com sua ressecção e anastomose bíleodigestiva é seguro, mesmo em crianças pequenas. .

Morphologic study of embryonic development of rat duodenum through a computerized three-dimensional reconstruction: critical analysis of solid core theory.

To date, intrinsic obstructions of the duodenum have been explained by the "solid core" theory, described by Tandler in 1902 (Morphol Jahrb 29:187-216, 1902). This study aimed to evaluate the epithelial occlusion of rat duodenum during embryonic development, through optical microscopy and computerized three-dimensional reconstruction. The Wistar rat embryos used in this study had 13, 14, 15, and 16 days of gestation. This corresponds to human embryos with 33, 40, 44, and 52 days of development, which is between the fifth and eighth week. The study included 12 embryos studied by optical microscopy, and four by three-dimensional reconstruction (those with 13, 14, 15, and 16 days). Through optical microscopy, an intense epithelial proliferation was observed in the gestation embryo of 13 days, with no occlusion of the opening of the duodenum. In the embryos with 14, 15, and 16 days of gestation, an increase in diameter of the duodenum was observed along with intestinal development. Through three-dimensional reconstruction, it was observed that the opening of the digestive tube of rat embryos with 13-16 days of gestation is never obstructed by epithelial proliferation, although it may follow a sinuous path. This study concludes that the "solid core" phase described by Tandler does not occur in the embryonic development of rat duodenum.

Hepatobiliary effects of cholic and lithocholic acids: experimental study in hamsters.

Etiopathogenesis of biliary atresia remains unknown. Among several theories, one proposes that the disorder may be caused by the toxic effect of monohydroxy bile acids on fetal and neonatal hepatobiliary system. In this paper we evaluated toxic effects produced by ingestion of cholic acid, a trihydroxy bile acid, and lithocholic acid, a monohydroxy bile acid in the hepatobiliary system of a hamster during gestational and perinatal periods. A diet composed by 0.5% cholic acid and 0.25% lithocholic acid was administrated to pregnant hamsters. Liver and bile ducts of the adult and newborn animals were analyzed to point out the changes induced by these acids after birth. Because hamsters and humans have a similar bile metabolism, these animals were eligible for the study. The ingestion of 0.5% lithocholic acid, during hamster's gestation, caused maternal intense ductal/ductular proliferation, inflammatory signs, hepatic cells degeneration and regeneration, hyperplasia of extra hepatic ducts epithelium, and abortion. Both 0.5% cholic acid and 0.25% lithocholic acid ingested by pregnant hamsters, caused ductal/ductular proliferation and hepatobiliary inflammatory damage in a different degree of intensity in adult animals and mild intensity in the young; and also the number of the young was reduced in the litter. We found that the ingestion of these bile acids by hamsters, during gestational period caused different degrees of toxicity on maternal and neonatal hepatobiliary systems. The histopathologic findings observed in biliary atresia patients could not be found in newborn hamsters. New experimental models are needed in the attempt to establish a correlation of these acids with neonatal cholestatic diseases.

Estudo comparativo entre as técnicas de nissen e Boix-Ochoa em ratos / Comparative study between the techniques of the nissen and Boix-Ochoa in rats

OBJETIVO: Comparar, em ratos, a eficiência das técnicas de Nissen e Boix-Ochoa no tratamento do refluxo gastroesofagiano (RGE) induzido pela operação de Heller. MÉTODO: Foram usados 30 ratos Wistar, com idades entre 40 e 60 dias de vida e peso corporal entre 210 g e 342 g. Os animais foram distribuídos em três Grupos (A, B, C) de 10 ratos. Em todos os animais realizou-se a operação de Heller. No Grupo B ela foi seguida de uma operação de Nissen e, no Grupo C, de uma operação de Boix-Ochoa. A pressão intra-gástrica necessária para produzir RGE foi medida em todos os animais: antes de qualquer procedimento; imediatamente após as operações de Heller, Nissen e Boix-Ochoa; e seis semanas depois, quando os animais foram mortos. RESULTADOS: Verificou-se que tanto a recuperação da perda de peso, que caracteriza o quadro de RGE, como a reconstituição mais fisiológica dos gradientes pressóricos gastroesofagianos são obtidos de forma mais eficiente pela técnica de Boix- Ochoa. CONCLUSÃO: As operações de Nissen e Boix- Ochoa são eficientes no tratamento do RGE induzido pela técnica de Heller, em ratos. A segunda, no entanto, restaurou, de forma mais adequada, os valores fisiológicos dos parâmetros estudados neste trabalho: o peso corporal e os gradientes pressóricos gastroesofagianos.

OBJECTIVE: To compare, in rats, the efficiency of Nissen and Boix-Ochoa techniques in the treatment of gastroesophageal reflux (GER) induced by a Heller's procedure. METHOD: 30 rats Wistar aged between 40 and 60 days and weighing between 210 g and 342 g were used. The animals were divided in three (A,B,C) groups of 10 rats each. A Heller's operation was made in all the animals. In group B, it was followed by a Nissen procedure and, in group C, by a Boix-Ochoa procedure. The intragastric pressure necessary to produce reflux was mesured in all animals: before any procedure; immediately after the Heller, Nissen and Boix-Ochoa porcedures; and 6 weeks later, when the animals were killed. RESULTS: Restauration of body weight and reconstitution of more physiologic gastroesophageal pressure gradients were more effective with the Boix-Ochoa technique. CONCLUSION: the techniques of Nissen and Boix-Ochoa are effective in the treatment of GER induced by a Heller's procedure in rats. The second one, howerver, restaures, more adequately, the physiologic values of the two parameters used in this study: body weight and gastroesophageal pressure gradients.

Alterações hepatobiliares induzidas pelos ácidos cólico e litocólico: estudo experimental em hamsters / Hepatobiliaries alterations induced by cholic and lithocholic acids: hamsters experimental study

A atresia de vias biliares é a causa mais comum de icterícia obstrutiva, cirrose e transplante hepático da infância. Sua etiopatogenia permanente desconhecida. Dentre várias teorias, uma propõe que a enfermidade pode ser causada pelo efeito tóxico de ácidos biliares monohidroxilados no sistema hepatobiliar fetal e neonatal. As características do metabolismo biliar nesta fase da vida e possíveis alterações bioquímicas desses ácidos poderiam causar reaçäo inflamatória e obstruçäo ductal. Ainda näo foi feito qualquer estudo experimental da açäo desses ácidos sobre o sistema hepatobiliar durante a gravidez. Neste trabalho, avaliaram-se os efeitos tóxicos provocados pela ingestäo de um ácido biliar trihidroxilado, o cólico, e um monohidroxilado, o litocólico, sobre o sistema hepatobiliar de hamsters durante os períodos gestacional e perinatal. A escolha deste animal deve-se à semelhança de seu metabolismo biliar com o humano. A ingestäo de ácido litocólico a 0,5 por cento durante a gestaçäo de hamsters, provocou proliferaçäo ductal/ductular acentuada, sinais inflamatórios, degeneraçäo e regeneraçäo celular hepática, hiperplasia do epitélio dos ductos extra-hepáticos maternos e aborto. Tanto o ácido cólico a 0,5 por cento como o ácido litocólico a 0,25 por cento, quando ingeridos por hamsters grávidas, provocaram proliferaçäo ductal/ductular e lesäo inflamatória hepatobiliar em graus variáveis no animal adulto e de leve intensidade nos filhotes. Induziu, ainda, a reduçäo da ninhada. Portanto, verificou-se que a ingestäo destes ácidos biliares por hamsters durante o período gestacional provocou toxicidade variável sobre o sistema hepatobibliar materno e de recém-nascidos